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Employee Benefits Jobs
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Webcasts and Conferences
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[Guidance Overview]
Final Regulations Issued on Contraceptive Coverage, Religious and Eligible Organizations
"Self-insured plans must contract with a third-party administrator for the purpose of providing payments for contraceptive services. The third-party administrator will act as the plan administrator and process claims solely related to the payment of contraceptive services. Such administrators will be reimbursed for these payments through adjustments in their Federally Facilitated Exchange (FFE) user fees. On that basis and on the basis that the use of contraceptives reduces other medical expenses, the final regulations dismiss any notion that insurance issuers or third-party administrators are unable to bear the cost of contraceptive services, concluding that the effect is 'cost-neutral.'"
(Ballard Spahr)
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[Guidance Overview]
Mystery and Pitfalls Surround ACA's 95 Percent Rule
"The 95 percent rule allows an employer to be treated as offering qualifying coverage to all of its full-time employees (and their dependents) for a calendar month, if the employer offers coverage to all but five percent (or, if greater, five full-time employees) of its full-time employees (and their dependents). The preamble to the proposed regulations makes it clear an employer can utilize the 95 percent rule even if the failure to offer coverage is intentional. As a result, many employers have been looking for ways to exploit this rule to minimize their healthcare expenses."
(Moulder Law)
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[Guidance Overview]
CMS Proposes Security Incident Reporting Standards for Health Insurance Exchanges, Including 60-Minute Deadline
"Health insurance exchanges would be required to follow specific data security incident response procedures, including informing regulators within an hour of discovery of any actual or attempted unauthorized access to protected databases, under a proposed [CMS] rule ... The proposed rule does not include a risk of harm threshold to limit what kinds of incidents must be reported; nor is the reporting requirement tied to any number of individuals or number of records actually or potentially affected by an intrusion attempt or actual data breach."
(Bloomberg BNA)
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Is the Time Right for Private Health Insurance Exchanges?
"[S]hould your company consider moving your health insurance -- and potentially other benefits -- to a private exchange? The analysis actually starts with a strategy decision. Does a defined-contribution health or benefit plan make sense for the company?"
(Human Resource Executive Online)
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Iowa, South Dakota Blues to Skip Obamacare Exchange Next Year
"Blue Cross and Blue Shield plans, with a long history of selling medical insurance directly to consumers, are expected to provide much of the subsidized coverage sold through the health law's online marketplaces, or exchanges.... But ... Iowa and South Dakota became the second and third states in which there may be no Blues option when exchange consumers start shopping on Oct. 1. Citing concerns about its ability to deliver quality service as the marketplace ramps up, Wellmark Blue Cross and Blue Shield said it won't offer subsidized plans through those exchanges until 2015."
(Kaiser Health News)
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House Hearing Focuses on the Effects of ACA on Businesses
"Katie Mahoney, Executive Director of Health Policy with the U.S. Chamber of Commerce ... claimed [in her testimony at a hearing by the House Energy and Commerce Subcommittee on Oversight and Investigations] that on the whole, the law is eroding the employer-sponsored health benefits system. Specifically, she said the law will require employers to reduce hiring, work hours, and plans for expansion.... Small business owner Michael Brey [said] that ... many provisions of the ACA will benefit his business. He claimed that 96% of businesses have fewer than 50 employees, and therefore will not be subject to the pay or play penalties."
(Littler)
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Lockton Compliance News: Health Reform Edition, Summer 2013
22 pages. Excerpt: "We're now more than three years into the [ACA], and like any three-year-old, the law is moving about with increasing speed, albeit on wobbly legs. What it says is sometimes difficult to comprehend, but clarity is emerging."
(Lockton Benefit Group)
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Text of Recommendations to HHS on Handling of Attachments as Part of HIPAA-Covered Electronic Exchange of Claims Data (PDF)
Contains 18 specific recommendations. Excerpt: "The regulations should not define specific standards or methods of transport as the only ways for exchanging attachments. Standards being adopted should be agnostic of the transport selected by trading partners to exchange attachments, so as not to preclude or inhibit innovation. However, the regulations should remind covered entities of the importance of following reasonable and appropriate administrative, physical, and technical security policies and procedures when using and disclosing attachment information."
(National Committee on Vital and Health Statistics)
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How 'Aboot' That Obamacare? -- Why Health Reform Won't Turn Us Into Canada
"Each of Canada's 10 provinces runs a universal health care system, which guarantees all citizens access to hospital and physician services. Provinces can decide whether to include supplemental benefits like dental insurance or prescription drug coverage.... The big difference though is that, in Canada, the health insurer is a public entity whereas here they're private companies."
(The Washington Post)
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Pennsylvania Among 17 States Shifting Expensive High-Risk Insurance Pools to Federal Government
"Consumers enrolled in the so-called high-risk pool, PA Fair Care, have received letters telling them the transfer is automatic but that they may see 'changes to benefits, treatment plans, deductibles and access to provider networks.' ... The pools, which partially subsidize insurance premiums for people often in need of costly medical care, turned out to be more expensive than expected."
(Kaiser Health News)
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Text of GAO Report on HHS's Process for Awarding and Overseeing Exchange and Rate Review Grants to States
"PPACA required the establishment of health insurance exchanges and a process for the annual review of unreasonable increases in insurance premiums charged by issuers of health coverage in each state. To assist states in establishing exchanges and in enhancing their ability to review issuers' premium rate increases, the law established new grant programs under which HHS is authorized to award grants to states through 2014. The law appropriated an unspecified amount of funds for exchange grants, and appropriated $250 million to HHS for rate review grants.... In this report, GAO describes (1) the process HHS uses to award exchange and rate review grants to states; (2) the amounts of grants and key activities states funded through the grants; and (3) HHS's process for overseeing states' use of the grants."
(U.S. Government Accountability Office)
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[Opinion]
Deloitte Health Care Reform Memo, July 1, 2013
"Costs are largely unknown to consumers. They understand what they pay out-of-pocket as co-pays and deductibles and what they pay at retail for over-the-counter products and little more.... When all costs of health care are accounted for -- including things like supervisory care services for family members and other expenses not usually included in the industry's calculations -- we spend $10,392 per capita for health care in the U.S. and total out-of-pocket costs represent $404 billion. And the majority of consumers consider the system wasteful, inefficient and difficult to navigate."
(Deloitte)
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[Opinion]
Will New Laws in States with Federally Run Health Insurance Marketplaces Hinder Outreach?
"A state law that prohibits navigators from offering advice about the benefits, terms, and features of a particular health benefit plan could prevent a navigator from facilitating enrollment and helping individuals make informed decisions, as required under federal law.... Stringent standards could be a barrier for respected community-based organizations -- such as agricultural extension centers, churches, and safety-net health care providers -- that want to serve as navigators for underserved communities ... Many of these laws require the state's insurance department to further define navigator requirements in regulations."
(The Commonwealth Fund)
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[Opinion]
Public Outreach on Obamacare: The Cost of Educating the Public
"The dramatic difference in consumer assistance spending between state-based and federally facilitated exchanges may explain the efforts of Secretary Sebelius to extract outside funding for outreach. She has solicited funds from private corporations to further publicize the law and finance consumer outreach and enrollment activities via the nonprofit group Enroll America."
(The Heritage Foundation)
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[Opinion]
Toward a Scientific Approach to Workplace Wellness: A Response to Ron Goetzel
"[The authors] are skeptical that wellness programs of the sort encouraged by the [ACA] create, as Professor Goetzel suggests, a 'win-win-win' situation: good for all workers, good for society, and consistent with the financial interests of employers, firms, and their owners. Rather remarkably, despite the potential for workplace wellness to become a large 'social experiment', we found scant reliable evidence that implementing wellness programs can easily save costs through health improvements without being discriminatory."
(John DiNardo, Jill Horwitz, and Brenna Kelly in Health Affairs)
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[Opinion]
Unreasonably High: Health Net's Premiums for Policies Listed on California's Exchange
"Health Net's rate plan relies on unreasonable assumptions about how sick the individual purchasers of these new health plans will be. By projecting new enrollees will use dramatically more health care services in the future compared to its current policyholders, Health Net claims that a higher rate is necessary. If the company used more reasonable projections, rates would likely be at least 20% lower than Health Net proposes, or an average $67 a month, for the thousands of Californians who will soon purchase Health Net PPO coverage in the exchange."
(Consumer Watchdog)
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Benefits in General; Executive Compensation
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[Guidance Overview]
What Does the DOMA Decision Mean for Employer-Sponsored Benefit Plans? (PDF)
"Employers will certainly need to amend their plans' definition of 'spouse' where the definition is based on federal law under DOMA. We do not yet know whether a single definition of spouse will be permitted or required, or whether the definition will depend on the employee's state of residence, or on the state in which the marriage was performed, or some other standard. In addition, plan procedures ... will need to be changed to incorporate the relevant provisions for same-sex spouses in the case of a state-recognized marriage."
(PricewaterhouseCoopers)
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[Guidance Overview]
DOMA's Demise Requires Immediate Action by Benefit Plan Sponsors (PDF)
"Applying two separate benefit administration schemes -- one for states that recognize same-sex marriage and one for states that do not -- may seem easy at first blush. However, problems arise when an employee is married in a state that recognizes same-sex marriage but resides in a state that does not.... Using the state of residence is particularly problematic as today's workforce is highly mobile. Under this rule, an employee who was legally married and resides in the District of Columbia would lose all of the benefits listed ...if the employee moved only a few miles away to Virginia."
(Paul Hastings LLP)
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Employers Should Respond to DOMA With Steps That Offset Risks
"The DOMA ruling raises the question of 'to what extent does a plan administrator have the obligation to make these determinations versus putting the burden on the participant or the claimant?' said Louis T. Mazawey, a principal at Groom Law Group in Washington. The court's decision on DOMA also might cause some employers to reconsider their offer of same-sex benefits to domestic partners, at least in those states that recognize same-sex marriages."
(Bloomberg BNA)
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DOL Investigations: What Plan Sponsors and Service-Providers Can Expect (PDF)
"Sometimes the DOL's initial letter will request that documents be provided on-site for inspection by the DOL investigator. It is often more efficient and less disruptive to the ongoing business operations of the entity being investigated to provide documents directly to the investigator, rather than have the investigator on-site for the initial document review.... Some service providers are contractually limited from disclosing client information. These limitations may include requiring prior notice to the client and/or responding only to a subpoena (rather than an information request). It is important to keep these limitations in mind when considering the steps necessary to address a request for information."
(Groom Law Group, in Bloomberg BNA Pension & Benefits Daily)
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Surprising Victory in Delaware for Plaintiffs Alleging Excessive/Improper Compensation
"The Court's decision came down to a relatively narrow issue of whether the Company's amendment of its stock incentive plan to allow a slightly different type of award required stockholder approval. However, the transcript of the bench ruling includes several hints of the possibility of a dramatic shift in Delaware courts' attitudes toward executive compensation lawsuits."
(Winston & Strawn LLP)
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[Opinion]
Text of Comments by U.S. Chamber of Commerce to IRS on the $500,000 Deduction Limitation for Remuneration Provided by Certain Health Insurance Providers (PDF)
"The Chamber has serious concerns that the caps on compensation deductibility, as required under the PPACA will have an adverse impact upon the operation and competitive position of health insurance providers.... [T]he section 9014 cap places health insurance providers on a different level than every other public company in the United States who can deduct up to $1 million in executive compensation. While compensation deductibility caps for public companies only apply to the Chief Executive Officer and the top four executives, section 9014 is much broader ... [C]ompensation deduction caps have not achieved their intended purpose and have led to other forms of compensation at higher levels."
(U.S. Chamber of Commerce's Health Care Solutions Council)
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Press Releases
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